Customer Complaint Form

C C u u s s t t o o m m e e r r C C o o m m p p l l a a i i n n t t F F o o r r m m

1 1 . .

C C u u s s t t o o m m e e r r d d e e t t a a i i l l s s

Title (Mr, Mrs, etc) Family name (surname)

Given names

Street address

Suburb

Postcode

Home telephone number

Business telephone number

Mobile telephone number

Email address (if applicable)

2 2 . .

D D e e t t a a i i l l s s o o f f o o t t h h e e r r p p e e r r s s o o n n o o r r s s u u p p p p l l i i e e r r i i n n v v o o l l v v e e d d i i n n t t h h i i s s c c o o m m p p l l a a i i n n t t

Name

Street address

Suburb

Postcode

Home telephone number

Business telephone number

Mobile telephone number

Email address (if applicable)

3 3 . .

D D e e t t a a i i l l s s o o f f g g o o o o d d s s o o r r s s e e r r v v i i c c e e s s s s u u p p p p l l i i e e d d t t o o t t h h e e c c u u s s t t o o m m e e r r

Date of purchase or service

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Description of the goods or service including make, model, type of service, purchase method, etc.

4 4 . .

D D e e t t a a i i l l s s o o f f w w h h a a t t t t h h e e c c u u s s t t o o m m e e r r c c o o m m p p l l a a i i n n t t i i s s

O O f f f f i i c c e e u u s s e e o o n n l l y y

Complaint received by

Date received

In person

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In writing

Action taken or required

Date action completed

Signature

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